Self Help UK


Beyond Diagnosis service request form

Self Help UK in partnership with Macmillan deliver a project offering emotional and practical support to people living with cancer in the Nottingham, Mansfield and Ashfield areas.

The project can offer practical or emotional support. A client will be contacted by the project within 7 working days of this form being received.

Client details

Cancer diagnosis/family member or carer?
Yes/No/Unsure?
Who is involved?
Are there any known risks e.g. history of aggression or violence?
Are there any pets within the household?
Yes/No?